@layout("/common/_container.html",{bg:"bg-white",js:["/assets/modular/chain/public/public_add.js"]}){

<form id="publicForm" lay-filter="publicForm" class="layui-form model-form">
    <input name="publicId" type="hidden"/>

    <div class="layui-form-item">
        <label class="layui-form-label">提币地址<span style="color: red;">*</span></label>
        <div class="layui-input-block">
            <input name="toAddress" id="toAddress" placeholder="请输入提币地址" type="text" class="layui-input" lay-verify="required" required/>
        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label">币种</label>
        <div class="layui-input-block">
            <select  name="coin" id="coin" >
                <option value="ETH">ETH</option>
                <option value="ETH_USDT">USDT</option>
<!--                <option value="MGM">MGM</option>-->
<!--                <option value="MGE">MGE</option>-->
            </select>
        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label">提币数量<span style="color: red;">*</span></label>
        <div class="layui-input-block">
            <input name="price" id="price" placeholder="请输入提币数量" type="text" class="layui-input" lay-verify="required" required/>
        </div>
    </div>
    <div class="layui-form-item">
        <label class="layui-form-label">谷歌验证码<span style="color: red;">*</span></label>
        <div class="layui-input-block">
            <input name="code" id="code" placeholder="请输入谷歌验证码" type="text" class="layui-input" lay-verify="required" required/>
        </div>
    </div>
    <div class="layui-form-item text-right">
        <button class="layui-btn layui-btn-primary" type="button" ew-event="closeDialog">取消</button>
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>提交</button>
    </div>
</form>
@}